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Family Medicine > FM CASE FILES 2 > Flashcards

FM CASE FILES 2 Flashcards

1
Q

tx for GBS during pregnancy

A

penicillin

others: ampicillin, cephalothin, erythromycin, clinda

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2
Q

how to confirm rupture of membranes

A

see amniotic fluid leaking from cervix

polling of amniotic fluid in vaginal fornix

Nitrazine paper - pH >6.5 in vaginal fluid

ferning on dried slide

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3
Q

prolonged rupture of membranes predisposes to what

A

infection

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4
Q

define first stage of labor

A

contractions until complete cervical dilation

latent phase

active phase - starts at 4cm

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5
Q

rate of dilatation

epidural vs nonepidural

A

NO EPIDURAL

  1. 2cm / hr (nulliparous)
  2. 5cm / hr (parous)
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6
Q

define second stage of labor

A

delivery of fetus

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7
Q

normal duration of 2nd stage of labor

A 
2 hours (nulliparous)
1 hour (parous)

epidural can prolong these times by 1 hour

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8
Q

normal duration of 3rd stage of labor

A

30 min

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9
Q

labor depends on 3Ps

A

power (strength of contractions)

passenger (size, lie, position)

pelvis (shape and size)

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10
Q

what can cause of false-positive nitrazine test

A

semen
blood
bacterial vaginosis

all can elevate pH

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11
Q

how do you assess fetal well being when mother is admitted to L&D

A

fetal heart rate monitoring

with a doppler ultrasound

or fetal scalp electrode
(requires membranes to be ruptured)

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12
Q

what 3 things do you look at in fetal heart rate tracings

A

baseline heart rate
variability
heart rate changes

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13
Q

normal baseline heart rate of fetus

A

110-160

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14
Q

normal variability of fetus

A

3-5 cycles per minute

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15
Q

comomn causes of decreased fetal heart rate variability

A

fetus sleeping
cns depressants (narcotic analgesics)
prematurity
fetal acidemia 2nd to hypoxemia

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16
Q

define fetal heart rate accel

A

15 beats/min

15 sec

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17
Q

what causes early decels

A

compression of fetal head

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18
Q

what causes late decel

A

uteroplacental insufficiency

causes:
maternal hypotension (given epidural or oxytocin)
maternal HTN, DM, placental abruptio

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19
Q

what causes variable decel

A

umbilical cord compression during contractions

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20
Q

what do you use to monitor uterine contractions and its strength

A

external toco

strength: IUPC (need ruptured membranres)

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21
Q

giving too much oxytocin during labor can result in what consequence

A

uterine hyperstimulation

late decels

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22
Q

cardinal movements during labor

A

refers to movement of fetal head

flexion
internal rotation (occiput to move anteriorly - symphysis)
extension
external rotation

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23
Q

maneuvers for shoulder dystocia

A

McRoberts Maneuver (hyperflexion)
suprapublic pressure
episiotomy

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24
Q

most calcium is found where in the body?

A

bones - 98% of total

bound to albumin - 1%
watch out for low albumin, causing low calcium (correct for this)

free - 1% (active)

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25
Q

formula for corrected serum calcium

A

corrected calcium =

[normal albumin - serum albumin] X 0.8(serum calcium)

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26
Q

what hormone decreases serum calcium and how?

A

calcitonin

causes increased renal excretion

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27
Q

what hormone increases serum calcium and how?

A

PTH

increases bone resorption by activating osteoclast

promotes kidney resorption

promotes GI absorption through calcitriol

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28
Q

most common cause of hypercalcemia

A

hyperparathyroidism

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29
Q

signs and sx

hypercalcemia

A

kidney stones
bone pain (arthritis, etc)
psychic (poor concentration, weakness, fatigue)
abdominal (pain, constipation, NV, pancreatitis)

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30
Q

first thing you look at when a pt has hypercalcemia

A

look at meds they’re taking

stop the suspected med

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31
Q

if a pt has hypercalcemia, what is the next step

A

order PTH

if PTH is low, feedback loop is working fine

if PTH is high or normal, feedback is not fine
(primary hyperparathyroidism)

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32
Q

how do you distinguish between primary hyperparathyroidism vs familial hypocalciuric hypercalcemia (FHH)

A

FHH is a genetic disorder

measure 24-hour urinary calcium
FHH: low calcium level
hyperparathyroidism: normal or elevated urinary calcium

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33
Q

if hypercalcemia, if PTH is low and Ca2+ is high, what lab test do you order next?

A

PTH-rP
parathyroid hormone related peptide

this is produced by cancers
lung, SCC of head and neck, kidney cx

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34
Q

how does PTH-rP work

A

osteoclast bone resorption
increases calcitriol (uptake in gut)
inc kidney resorption

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35
Q

tx for primary hyperparathyroidism

A

surgical removal of the adenoma

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36
Q

activities of daily living

A 
bath
dress
eat
toilet
continence
transfer from bed to chair
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37
Q

instrumental activities of daily living

A 
transportation
shop
cook
telephone
manage money
take meds
housecleaning
laundry
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38
Q

leading cause of blindness in elderly

A

age-related macular degeneration

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39
Q

what is macular degeneration

A

atrophy of cells in central macular region

leading to central vision loss

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40
Q

what is glaucoma

what is responsible for the disease

A

increased intraocular pressure

optic neuropathy

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41
Q

most common cause of blindness worldwide

A

cataracts

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42
Q

leading cause of blindness in working age adults in US

A

diabetic retinopathy

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43
Q

what is presbycusis

how does it present

A

age-related hearing loss

sensorineural hearing loss results in:
high-frequency loss
difficulty with speech discrimination

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44
Q

what is otosclerosis

A

autosomal dominant disorder of inner ear bones

loss of conduction

presents in 20-40s
speech discrimination is preserved

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45
Q

what is CAPD and contrast it with presbycusis

A

central auditory processing disorder
(CNS dysfxn)

has difficulty understanding spoken language
but hears sound well

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46
Q

quick cognitive screening test for dementia

A

clock draw

three-item recall

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47
Q

immunizations for ppl over 65

A

annual influenza
pneumococcal once
DPT booster

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48
Q

acute bronchitis

which antibiotic

A

none

antibiotics has not been shown to benefit

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49
Q

orgs in bacterial sinusitis (adults)

A

pneumococcus

h influenzae

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50
Q

orgs in bacterial sinusitis (children)

A

pneumococcus
h influenzae
moraxella catarrhalis

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51
Q

tx for acute sinusitis

A

first line
amoxicillin and bactrim

if fail, then 2nd line
amoxicillin-clavulanic acid
2nd/3rd gen cephalo
quinolones
macrolides (azithro)
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52
Q

common causes of pharyngitis in teens/young adults

A

group A strep
mycoplasma pneumoniae
chlamydia pneumonia
arcanobacterium haemolyticus

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53
Q

group A strep findings

A 
ABRUPT onset of sore throat/fever
tonsillar/palatal petchiae
tender cevical adenopathy
NO COUGH
sandpaperlike rash (scarlatiniform)
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54
Q

signs of

infectious mono

A

cervical and generalized adenopathy
HSM
atypical lymphocytes on smear

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55
Q

complication of infectious mono

A

splenic rupture to trauma

restrict sports

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56
Q

signs and sx
epiglottitis

cause?

A

stridor
drooling
toxic appearance
leaning forward (tripod position)

H influ

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57
Q

differential dx of tonsillar exudates

A 
GAS
EBV
mycoplasma
chlamydia
adenoviruses

note: having tonsillar exudates does not automatically mean its bacteria vs virus

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58
Q

signs and sx

peritonsillar abscess

A

tonsil is pushed toward midline

uvula deviation

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59
Q

tx of peritonsillar abscess

A

surgical drainage

60
Q

causes of peritonsillar abscess

A

strep

GAS

61
Q

complications of GAS

A 
rheumatic fever
glomerulonephritis
toxic shock syndrome
peritonsillar abscess
meningitis
62
Q

does tx prevent poststreptococcal glomeruloneprhitis

A

NO

you can get it either way

63
Q

tx for GAS

A

10-day course of oral penicillin

64
Q

what is swimmer’s ear and what causes it

A

otitis externa

pseudomonas aeruginosa

65
Q

common causes of otitis media

A

s pneumo
h influe
m catarrhalis

66
Q

tx for otitis media

A

aomxicillin

alternative
amox/clavu
bactrim
2nd/3rd gen cephalosporins

67
Q

immediate tx for chest pain

A

MONA

morphine
oxygen
nitro
aspirin

beta blocker

68
Q

how does cocaine induce angina?

A

coronary artery spasm

69
Q

patient is on clopidogrel needs bypass surgery, what do you do next?

A

withhold clopidogrel for 5-7 days before surgery

70
Q

what is unstable angina

what is the immediate treatment

A

angina at rest

give platelet inhibitors gIIb/IIIa

71
Q

how are beta blockers helpful in MIs

A

reduces infarct size

decreases mortality

reduces risk of another one

72
Q

how are ace-i helpful in MIs

A

reduces shor-tterm mortality if started within 24 hours of MI

prevents LV remodeling

73
Q

hypomagnesemia increases risk of what

A

torsades de pointes

74
Q

what is benefit of CCB in MIs

which CCB is contraindicated in MIs

A

none

nifedipine - increases mortality

75
Q

diet for MI patients

A

low saturated fat and cholesterol

76
Q

risk factors for CAD

A 
DM
HLD
age
HTN
smoking
family hx of CAD
Male
postmenopausal
LVH
homocystinemia
77
Q

why give statins right after having ACS

A

decreases incidence of major adverse cardiovascular events

78
Q

what is goal LDL if using statins after MI

A

< 70

79
Q

minimum duration of exercise

A

30 min

80
Q

minimum weight reduction to get benefits

A

5% minimum

81
Q

what is the Levine Sign

A

holding fist to chest

sign of MI

82
Q

unequal upper extremity pulses is a sign of what

A

aortic dissection

83
Q

tx for elevated potassium

A

kayexalate
insulin
retention enemas

84
Q

causes of chronic renal failure

A

DM
HTN
glomerulonephritis

85
Q

drugs that affect kidney fxn

A

nsaids
aminoglycosides
contrast

86
Q

in chronic renal failure, what is the first step in management

A 
remove anything that reduces renal perfusion:
hypovolemia (give IV fluids)
hypotension
infection --> sepsis
drugs that lower GFR like nsaids
87
Q

goal of BP tx in chronic renal failure

A

< 130/80

88
Q

what med do u treat BP with in chronic renal failure

A

ace-i

add diuretic if BP still not controlled

89
Q

microscopic exam of trichomonas vaginalis

A

motile
flagellated
many wbcs

90
Q

tx for trichomonas vaginalis

A

flagyl 2g one dose

and for partner as well

91
Q

signs and sx

trichomonas vaginalis

A

green frothy discharge

strawberry cervix

92
Q

vaginitis with recent abx use

what org is it

A

candida

93
Q

vaginitis in a DM pt

what org is it

A

candida

94
Q

describe candidal vaginitis

A

white discharge
no odor
VERY itchy

involves vulvar and vaginal areas (outside and inside)

95
Q

tx for candidal vaginitis

A

single dose fluconazole
or
creams/vaginal suppositories

96
Q

should you treat sexual partners of women with candidal vaginitis?

A

no, unless symptomatic

97
Q

signs / sx

gardnerella vaginalis

A

pH > 4.5
positive KOH “whiff” test (fishy odor after adding KOH
clue cells on wet mount

98
Q

tx for gardnerella vaginalis

A

metronidazole or clindamycin

oral or vaginal preparations

99
Q

should sexual partners of gardnerella vaginosis be treated?

A

not necessary

as it does not reduce risk of recurrent infection

100
Q

tx for gonorrhea

A

CTX

or Cipro

101
Q

tx for chlamydia

A

doxycycline x 7 days
or azithromycin ONCE

and treat partners

102
Q

what is PID

A

pelvic inflammatory disease

103
Q

signs and sx

PID

A 
inflammation of any of the reproductive organs
ovaries
fallopian tubes
uterus
cervix
vagina

all you need for dx:
cervical motion tenderness
adnexal tenderness

104
Q

tx for PID in prego woman or HIV

A

admit

parenteral abx

105
Q

complications of PID

A 
recurrence
tuboovarian abscess
chronic abdominal pain
infertility
ectopic pregnancy
106
Q

diagnostic test for lower GIB

A

colonoscopy

107
Q

what are hemorrhoids

A

dilated veins in the hemorrhoidal plexus of the anus

108
Q

risk factors for hemorrhoids

A

chronic constipation
straining for BMs
pregnancy
prolonged sitting (truck drivers)

109
Q

where do diverticula mostly occur

A

where blood vessels penetrate thru muscles of the colon

110
Q

signs and sx

diverticulosis

A

painless bleeding

111
Q

management of asymptomatic diverticulosis

A

dietary modification

high-fiber diet

112
Q

management of hemorrhoids

A

high-fiver diet

stool softeners

113
Q

contrast diverticulitis and diverticulosis

A

itis - painful inflammation

osis - not painful

114
Q

usual location of diverticulitis

A

lower left quadrant

115
Q

complication of diveritculitis

A

perforation resulting in:

peritonitis
intraabdominal abscess

116
Q

tx for diverticulitis

A

bowel rest
abx (quinolone and metro)

if perforated –> surgery

117
Q

major risk factor for IBD

A

family hx

118
Q

IBD

besides GI, what are other common manifestations

A

arthritis

119
Q

tx for IBD

A

symptomatic therapy
antidiarrheal
aminosalicylates
corticosteroids

120
Q

precancerous polyps

name the 3

A

in order of increasing risk
tubular adenomas
tubulovillous adenomas
VILLOUS ADENOMAS

121
Q

most common causes of CAP

A

pneumococcus

others
h influ
moraxella catarrhalis

common in very young and old

122
Q

cause of pneumonia in COPD patients

A

h influ

123
Q

atypical pneumonia

A

mycoplasma pneumonia
chlamydia pneumoniae
legionalla pneumphila

common in adolescent or young adults

124
Q

risk factors for hospital acquired pna

A

intubation
NG tube
preexisting lung disease
multisystem failure

125
Q

orgs in hospital acquired pna

A

aerobic GM-
pseudomonas
klebsiella
acinetobacter

GM+ cocci
staph aureus

126
Q

ways to reduce intubation associated pna

A

use oropharyngeal vs naso
elevate head during feeds
infection control (wash hands, alcohol based disinfectants)

127
Q

pneumonia with diarrhea

what bug

A

legionella

128
Q

pneumonia after influenza

A

staph aureus

129
Q

abrupt onset of pna

A

pneumococcus

130
Q

sign of focal lung consolidation

A

egophony (E to A change)

131
Q

sign of pleural effusion

A

dullness to percussion

132
Q

cxr

ground glass infiltrates

A

pneumocystis carinii

AIDS patients

133
Q

GI aspiration usually affects what lobe

A

right lower lobe

due to branching of bronchial tree

134
Q

how to diagnose legionella

A

urine antigen testing

135
Q

tx for pneumococcus pneumonia

A

beta lactam (ctx) or macrolide (azithromycin)

136
Q

complications of pna

A

bacteremia

pleural effusion

137
Q

tx for pleural effusion

A

if lots of fluid, do a thoracentesis with gram stain/cx

if empyema fluid, place chest tube for drainage

138
Q

differential dx

depression

A

hypothyroidism
anemia
substance abuse

139
Q

tx duration for depression

A

at least 6-9 months

if recurrent depression, treat for longer

140
Q

side effects

SSRI

A 
sexual dysfxn
weight gain
GI disturbance
fatigue
agitation
141
Q

side effects

TCA

A 
sedation
dry mouth and eyes
urinary retention
wt gain
sexual dysfxn
HIGHLY TOXIC / FATAL IN OD
142
Q

side effects

MAO-I

A

drug-drug interactions

SSRI and meperidine (Demerol)

143
Q

side effect

buproprion

A

seizure

contraindicated in pts with seizure disorders

144
Q

side effect

trazodone

A

priapism (persistent erection)

sedation (used for insomnia)

145
Q

comorbidity of panic disorders

A

depression

146
Q

bereavement vs depression

A

bereavement < 2 months

no suicidal ideations or psychosis

147
Q

rule out what in depressed patients

A

bipolar

ask about mania

Family Medicine (6 decks)

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